What lifestyle modifications or non-pharmacological interventions can I suggest to patients experiencing heavy menstrual bleeding?

Lifestyle modifications and non-pharmacological interventions for patients experiencing heavy menstrual bleeding (HMB) primarily focus on education, reassurance, and symptom management rather than direct reduction of blood loss.

• Provide women with information about the natural variability and range of menstrual blood loss to offer reassurance if their bleeding falls within normal limits, which may reduce anxiety and improve quality of life.

• Discuss the impact of HMB on quality of life and involve women in shared decision-making about their care, ensuring that treatment aims to improve their overall well-being rather than solely focusing on blood loss.

• Advise on the use of non-pharmacological symptom relief methods such as managing pain with nonsteroidal anti-inflammatory drugs (NSAIDs), which also have a role in reducing bleeding by inhibiting prostaglandin synthesis, although this is a pharmacological intervention.

• Encourage women to maintain a healthy lifestyle, including balanced nutrition and iron-rich diet, to help manage or prevent iron deficiency anemia associated with HMB, although routine serum ferritin testing is not recommended unless clinically indicated.

• Offer appropriate support and information resources, such as NHS websites and decision support tools, to empower women in managing their symptoms and understanding treatment options.

Note: The guidelines do not specify direct lifestyle changes or purely non-pharmacological interventions that reduce menstrual blood loss; most effective treatments involve pharmacological or surgical options. However, reassurance, education, and symptom management are key non-pharmacological components of care.

For pharmacological and surgical treatments, refer to NICE guidelines and CKS topics as appropriate.

¹,²